Multisectoralism, Participation, and Stakeholder Effectiveness: Increasing the Role of Nonstate Actors in the Global Fund to Fight AIDS, Tuberculosis, and Malaria

Abstract

During the past ten years there has been an increased willingness by international health organizations to include multisectoral nonstate actors in their decisionmaking processes. The stated aim of expanding multi-sectoral involvement is to increase information flows from those on the ground, to create a sense of policy ownership by those implementing various health programs, to create a more unified front against global health priorities, and to create a more robust sense of institutional legitimacy. One such institution has been the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was designed specifically to bring various stakeholders together to create a more coordinated mechanism to combat three of the world's most destructive diseases. The purpose of this essay is to discuss the role of nonstate actors in the decisionmaking processes of the Global Fund. The aim of this discussion is not to undermine the good work of the Global Fund, but to expose certain structural weaknesses in the current way nonstate actors are incorporated into the governance process and to illustrate how these structural processes might negate their effective participation. By doing so, this exploration will help expose various deficit gaps between the stated aims of multisectoral within the Global Fund and its actual practice. The goal is to encourage normative recommendations for increasing the real-world operation of stakeholder inclusiveness, ownership, partnership, and within the Global Fund. The Global Fund and Its Multisectoral Foundations To get a sense of the multisectoral dimension of the Global Fund, it is useful to outline some of the reasons why the Global Fund was established and to highlight the guiding principles that underwrite its mandate. The foundations for the Global Fund were laid at a G8 summit in Okinawa, Japan, in the year 2000. From that meeting, the G8 leaders acknowledged the need to create a new global health partnership to respond to increasing global health priorities. Linking effectiveness to inclusive multisectoral participation, the G8 leaders claimed that through sustained action and coherent international cooperation to fully mobilize new and existing medical, technical and financial resources, can we strengthen health delivery systems and reach beyond traditional approaches. (1) As was further exclaimed, the participation of developing country partners and other stakeholders will be essential. (2) By linking policy effectiveness to inclusive participation, five existing failures in multilateral global health governance were recognized. First, it was a widely held belief that there was a general lack of local expertise involved in global health governance and the decisionmaking process. Because of this, it was believed that global health governance failed to fully capture conditions on the ground and did not adequately reflect the particular constraints and conditions that were involved in each recipient country. Second, because of this lack of participatory input, it was felt that current global health policies lacked a sense of local ownership and that this often diminished the political will to follow through on implementation. Third, many donor countries maintained that there was a lack of institutional accountability measures within the existing United Nations system and that this acted as a disincentive for them to provide financial assistance. Fourth, it was believed that the current United Nations system had become overly political and diffident, so that effective global health policy and implementation could no longer be efficiently channeled through that body. Last, it was unanimously agreed that there was no unified and collective resource stream to fund global health priorities and that AIDS, tuberculosis, and malaria could be effectively managed only through a system of multisectoral cooperation, multisectoral dialogue, and a commitment to an internationally coordinated response. …